The great health care lie

Some people (who are generally purely ideologically motivated) have been spreading a great lie about how our health care systems actually function.

They say that the natural or automatic consequence of opening up Canada's health care system to private sector delivery and/or to some form of co-payments through private insurance would undermine universality. They say that if we were to open up to the private sector, our system would necessarily become Americanized and that only the rich would have access to quality care in a timely manner.

I will put aside for the purpose of this column the fact that this is actually a caricature of the American health care system (which, I will otherwise grant, has some major problems).

Yet, numerous examples from Europe and from all over the developed world show otherwise. Indeed, most European countries, if not all, let the private sector take a considerable place in their health care systems and are able to obtain better results than Canada in terms of accessibility and quality of care, according to several official rankings.

For example, in Germany, one third of hospitals are for-profit. Their number has almost doubled in the last 20 years. These hospitals provide care of higher quality than public or private not-for-profit hospitals, according to official evaluations from the German government. Moreover, they admit patients faster than public hospitals.

They don't only treat the simplest cases. In fact, private hospitals treat more complex cases and patients older than the average of German hospitals. And all of this in a context where the German health care system is universal: all citizens are covered by health insurance and can be treated in the hospital of their choice.

In France, where 38% of hospitals are run for profit, the system is also universal and access to care is not only reserved to those with the ability to pay, quite the contrary. Indeed, the private sector has developed in underserved areas, where public hospitals failed to meet the needs of the population. In addition, the private sector is located in poorer areas and relatively absent in richer areas.

Regarding the financing of health care, Canadians should have the choice to buy private insurance covering the same services as Medicare. Many countries allow duplicate private health insurance, including Australia, New Zealand, the United Kingdom and Denmark.

These countries have improved access to health care without compromising universality. The waiting time before getting treatment is on average half as long as in Canada.

In Denmark, for instance, the percentage of people covered by duplicate private insurance has increased from 1% in 2001 to 36% in 2007. Meanwhile, the average waiting time for elective surgery has decreased by 33% during the same period. A study has established that these two phenomena, at least in part, some causal link.

Canada is alone among developed countries in prohibiting physicians from practising in both the public and the private sectors.

In Australia, for instance, doctors who have a dual practice are working 48 hours a week on average, 11% more hours than those who practise only in the public system. In England and Denmark, studies have shown that physicians who practise in both sectors increase the overall number of hours allocated to treat patients without reducing the supply of services they devote to the public sector.

Given all of these facts, it is high time for Canadians to know the truth about the real effects of the presence of the private sector in health care.

Michel Kelly-Gagnon is President and CEO of the Montreal Economic Institute. The views reflected in this column are his own.
* This column appears in Sun Media newspapers, published both in several of Canada's key urban markets (Toronto, Ottawa, Calgary, Edmonton, Winnipeg and London) and in its 28 community dailies.

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